Please note: This blog contains descriptions of sexual assault.
“Recent reports of medical students performing pelvic exams for training purposes on anesthetized women without their consent”—or their knowledge—“have produced a firestorm of controversy and calls for greater regulation.” However, that “burst of public outcry” was in the mid-1990s. California was the first state to make the practice illegal, but the “early gains quickly petered out.”
As I discuss in my video Ending the Hidden Practice of Pelvic Exams on Unconscious Women Without Their Consent, “This practice, common since the late 1800s, was largely unchallenged until a 2003 study reported that 90 percent of medical students who completed obstetrics and gynecology (ob-gyn) rotations at four Philadelphia-area medical schools performed pelvic exams on anesthetized women for educational purposes.” (A subsequent study found the percentage to be lower than that in other areas of the country.) The bottom line? “Pelvic Exams Done on Anesthetized Women Without Consent: Still Happening.” How can this continue into 2025? Medical ethicists have called such practices “immoral and indefensible.” “At the end of the day, this is a practice that should come to an abrupt and immediate halt.” Some schools vowed they’d end the practice, but, unfortunately, these early victories quickly stalled. At the same time, a handful of schools revamped their policies, an equal number of hospitals and medical schools publicly dug in, defending the practice.
The Association of Professors of Gynecology and Obstetrics wrote: “As medical educators, we must balance our obligation to develop the next generation of physicians with women’s freedom to decide from whom they receive treatment and what aspects of their care are performed by learners.” “Some especially blunt teaching faculty contend that ‘public’ patients”—those without health insurance—“owe it to the facility and society to participate since they receive free or subsidized care.” Regulations to curb this practice are said to be “placing inappropriate and unnecessary barriers in the way of medical students who need to learn fundamental medical skills” and therefore “should be resisted.” Unsurprisingly, medical students still perform pelvic exams on anesthetized women.
Professional medical societies have given lip service to the concept of asking for explicit consent, but despite the recommendations, “evidence…suggests that the practice is alive and well.” And the “unauthorized use of women is not a localized phenomenon confined to a handful of errant medical schools,” a few bad med school apples, but an international problem.
Even with the emergence of the #MeToo movement and even after Larry Nasser, the infamous USA gymnastics doctor, was sentenced to 40 to 175 years in prison for touching women’s genitalia without their consent, “there are still women who are being used as teaching subjects for these exams without their permission, without their consent.”
A 2020 update from Yale’s Center for Bioethics was entitled: “A Pot Ignored Boils On: Sustained Calls for Explicit Consent of Intimate Medical Exams.” It reads, “Over the last 30 years, several parties—both within and external to medicine—have increasingly voiced opposition to these exams. Arguments from medical associations, legal scholars, ethicists, nurses, and some physicians have not compelled meaningful institutional change.” Yes, there is the lip service paid by medical associations recommending bans on pelvic exams without consent, but those statements are “advisory and incomplete. Associations simply do not have the capacity to compel systemic change, as evidenced by institutions’ inaction.” In response to the medical profession’s inability to police itself, many states have passed legislation to protect patients from this practice.
But, of course, if you are anesthetized, how would you even know if medical students are lining up or not? “Teaching hospitals take patients who are in the worst position to know what’s occurring—they are unconscious—and use them in ways that leave no physical signs and are often undocumented in the patients’ medical records.” So, when the media loses interest, as it has decade after decade, “what incentive is there for teaching faculty or hospitals to voluntarily change?” Perhaps, “when physicians start being threatened with litigation, they’ll start obtaining informed consent.” As one commentator wrote, “Hospital administrators who allow medical students in their facilities to perform pelvic examinations on unconsenting anesthetized women ought to consult with their legal counsel concerning the definition of rape in their jurisdiction.”
“The solution is simple: Just ask.” Ask women for permission. It’s their body, their choice. “But recent experience has shown that meaningful and complete hospital-by-hospital change is unlikely to come until a hospital or doctor pays a substantial award [in some lawsuit] for this error in ethical judgment. We believe that day is coming soon, lest that ignored pot finally boil over.
“Some defend it as harmless and say asking for consent would make it more likely that patients would say no, denying students a crucial part of their training.” When I first wrote about this practice more than 20 years ago in my book Heart Failure about my time in medical school, I talked about how I had gotten the same comments from my classmates: “A well-then-how-are-we-going-to-learn response. To even present such a question is to lose a bit of one’s humanity. The answer, of course, is we should learn from women who give their consent! And to do that—God forbid—we might actually have to first establish a relationship with the patient, a trust—talk to them even. We may have to treat them like human beings.”
It’s unconscionable that medical students are legally allowed to practice pelvic exams on anesthetized women without their consent. Even if you live in one of the states where this practice is technically illegal, how do you know the law will be respected once you’re unconscious? Maybe medical students should wear bodycams.
If you missed the related video, see Medical Students Practice Pelvic Exams on Anesthetized Women Without Their Consent.
